Cleft Lip Repair Surgery in India

At Pristyn Care, we provide safe and effective treatment for cleft lip. We understand that it can be very difficult to take care of a baby with a cleft lip. Thus, our doctors perform cleft lip repair surgery on children to help restore the normal appearance and function of the lip. We have an in-house team of well-trained and certified plastic surgeons. All of our surgeons are skilled in performing various types of cosmetic and reconstructive procedures, including cleft lip repair.

Along with having a highly experienced team of plastic surgeons, we also have our own clinics across the country to make advanced treatments easily accessible for everyone. We also have partnered hospitals that are well-equipped with state-of-the-art facilities, UDFDA-approved diagnostic and surgical tools, and modern amenities. Pristyn Care ensures that all of our patients receive optimal care under all circumstances without any hassle.

Clefts are most commonly polygenic and multifactorial in origin based on genetic and environmental factors. In many cases, a definite cause is not discovered. Either the mother, father, or both can pass the genes that can cause clefting.

Some factors that increase the likelihood of a child developing a cleft lip are-

• Having parents or other family members with a history of cleft lip. 
• Exposure to certain substances, such as cigarettes, alcohol, or other medications during pregnancy. 
• The mother was diagnosed with diabetes before pregnancy. 
• If the mother is obese during pregnancy.

Typically, a cleft or split in the lip is immediately identifiable at birth. It may appear as-

• A split in the lip that affects one or both sides of the face. 
• A split that appears as a small notch in the lip and extends to the gums and palate into the bottom of the nose. 
• There is a small gap or indentation in the lip (partial or incomplete cleft).

A lip cleft can be unilateral (one-sided) or bilateral (two-sided) due to the failure of fusion of the maxillary prominence and medial nasal process.

Children who are born with a cleft often require a tailored treatment plan to meet their individual needs. The typical care plan for cleft lip looks like this-

• Birth to 6 weeks- Feeding assistance, parent support, hearing tests, and pediatric assessment
• 3 to 6 months- Surgery to repair the cleft lip 
• 6 to 12 months- Surgery to repair cleft palate 
• 18 months- Speech assessment 
• 3 years- Speech assessment 
• 5 years- Speech assessment 
• 8 to 12 years- Bone graft to repair the cleft in the gum area
• 12 to 15 years- Orthodontic treatment and monitoring the jaw growth 

Throughout the growth period, the child needs to attend regular outpatient appointments with the doctor for proper monitoring of the problems. 

Diagnosis

As the surgery is usually performed on a child between 3 to 6 months of age, the child’s overall health is closely monitored. This includes examining the nutrition intake of the child to see if the weight gain is adequate. Besides the weight, the child’s breathing patterns are also monitored to ensure that he/she is not having breathing problems while eating.

Procedure

The goal of cleft lip surgery is to repair the split in the best way possible. The most common technique used is a rotation advancement repair which is carried out in the following steps-

• The child is given anesthesia (local or general) to numb the area that needs to be treated. 
• The plastic surgeon then makes an incision on each side of the cleft from the lip to the nostril. 
• Tissues on both sides of the cleft are realigned and rearranged to provide normal lip function and facilitate suckling. 
• Then the tissues are stitched together. 
• If there is a nasal split, it is also repaired during cleft lip repair surgery. 

The duration of the surgery varies from 1 to 2 hours depending on the severity of the condition and the type of repair done. In some cases, such as bilateral cleft lip, a second surgery is required that is performed a month apart from the first surgery.

Several healthcare providers are involved in child care, including surgeons, speech therapists, otolaryngologists, dentists, pediatricians, genetic counselors, etc. They combinedly determine the best surgical treatment plan for the child. 

The preparations take place in the following steps-

• The pediatrician examines the child a week before the surgery to ensure that he/she is healthy enough for the procedure. They will go over the child’s medical history and allergies and also ask the parents to stop giving the child certain medications a week before the surgery. 
• Specific eating and drinking instructions are also given to the child’s parents based on his/her age. This includes that no milk formula or cow’s milk is given to the child at least 6 hours before the surgery. 
• Breastfeeding is allowed four hours beforehand, and clear liquids up to 3 hours before the procedure. 
• No solid foods or baby food should be given to the child after midnight on the day of the surgery.

If there is any other thing that needs to be taken care of, the medical team will notify the parents accordingly. 

Undergoing cleft lip repair surgery is critical for the child’s development and quality of life. But that doesn’t mean that the surgery is risk-free. There are several risks and complications associated with the procedure. Thus, the surgeon will explain them in detail, and the parents are asked to sign the consent form to confirm that they fully understand the procedure and its potential risks. 

Possible cleft lip surgery risks include- 

• Allergic reaction to anesthesia 
• Bleeding and infection 
• Damage to the nerves, blood vessels, muscles, or auditory canal 
• Irregular healing of the scars
• Poor healing of the incisions 
• Asymmetry in the results 
• Respiratory problems after the surgery

Immediately after the surgery, expect the child to feel mild pain. He/she might be irritated, and the treated area will be swollen and bruised. 

Soft splints or cuffs are placed around the child’s arm to prevent them from touching his/her lip. This can further make the child uncomfortable and agitated. It is safe to feed breastmilk or formula shortly after the surgery, but there might be some difficulty in doing so.

An intravenous catheter will be attached to the child to give him/her fluids until he/she can drink. In most cases, hospitalization is not needed after cleft lip surgery. Thus, the child is discharged after a few hours, and the parents are given detailed instructions for post-operative care. 

The results of cleft lip repair surgery will be visible shortly. The overall recovery takes around one month, and as the body heals, the final results will be clearly visible. Throughout the recovery period, the parents have to follow the instructions below- 

• Follow the instructions given to feed the child. Baby food is generally safe to continue, but it must be watered down or eaten in a cup. 
• Straws are generally not safe to be used after cleft lip surgery. Instead, use a special bottle or syringe to feed the child formula or breastmilk. 
• The child’s face will be swollen or bruised for several days after the treatment. Make sure that the child doesn’t accidentally scratch his/her face, as it can make the swelling worse. 
• The stitches will take around one to two weeks to dissolve. Throughout this period, ensure that the incision site is clean and dry. 
• Once the stitches dissolve, a pink or red scar will remain on the skin. Initially, the scar may feel hard, but it will soften up in the upcoming days and weeks. To improve the scar’s appearance, the doctor may recommend using special ointment or gel. 
• While taking the child out in the sun, apply sunscreen on the scar otherwise, the skin can get burnt. 
• In the first week, the child will need pain medications. Give the medicines as directed to keep the pain in control. 

The child will be back to his/her usual behavior within a week after the surgery. And until the recovery is complete, continue following the instructions to make recovery smoother.

Children with cleft lips often experience a variety of challenges depending on the type and the extent of the cleft. The surgical repair addresses these challenges and helps the child to live a normal life. The key benefits of cleft lip repair surgery include the following-

• The parents will no longer have trouble feeding the child. 
• Babies with cleft lip and palate are at risk of developing a middle ear infection and experiencing hearing problems. The surgery resolves these concerns and reduces such risks. 
• If the cleft extends to the upper gum, the tooth development of the child can get affected. Surgery helps to prevent this from happening and allows proper development. 
• Both the lips and palate are necessary for speech. Most babies with cleft lip and palate have difficulty speaking clearly. The surgery resolves this and improves the child’s speech. 
• Children with cleft lips often face social, emotional, and behavioral challenges due to the appearance of the cleft lip. With surgical treatment, these challenges are resolved.